Oncology Nursing Test 1

Lecture 1-9

Unknown primaries

cancer spreads but doesn’t tell you where it came from

Incomplete carcinogen

needs a promoter

Complete carcinogen

directly causes cancer

3 steps for cancer development

initiation

promotion

progression (metastasis)

initiation - altered DNA, starts w/ normal cell

promotion - alters genetic info

progression (metastasis) - pre-neoplastic, neoplastic, neoplasm

cancer development definitions

proto-oncogenes

tells normal cells to do it or not (on/off)

can turn into oncogenes

oncogenes

tells cancer cells to do it or not (on/off)

tumor suppressor genes

everyone has (just depends if they work correctly) (pause proliferation to repair)

Cancer cells go through the whole cell cycle

don’t develop any faster, just lose restriction when it comes to resting state

doubling time

time it takes for tumor to double in size

• 30 doublings to reach 1 cm (size of marble) (able to see on x-ray)

• 10 more doublings = results in death

tumor heterogeneity

many cell types in one tumor, makes it hard to treat

blood and lymph

most common ways of metastasis

intravasation

cancer cells break away and spread by blood

homing

certain cancer cells like to go to certain sites

angiogenesis/neurovascularization

tumor develops own blood supply to thrive

sporadic

most common (no history, later in life, exposed to something), over 50 yrs old

inherited (hereditary)

more rare (passed down, usually requires promoter)

Familial

not specific gene mutation but common enough to know its not sporadic (older ages)

due to shared environment, simliar lifestyles, etc

absolute risk

measure of occurrence in a particular population over a specific time period

ex. 1 in 8 women develop breast cancer

relative risk

risk of developing disease w/risk factor compared to someone w/o risk factor

attributable risk

amount of disease caused by a risk factor & its prevention because we changed something in the population

ex. less smoking = less cancer

dysplasia

abnormal growth

hyperplasia

excessive growth

metaplasia

abnormal-appearing cells (cells present in area are not usually there)

think of mets

pleomorphism

difference in cell appearance

undifferentiated (anapalastic)

look immature, abnormal, and lack normal structure

more aggressive, grade 4 or higher

differentiated

mature, look like normal cells

grow slower (grade 1/low grade)

common sites of mets

lung: liver, adrenal glands, bone, and brain

breast: lymph nodes, bone, lung, liver, brain

stomach: liver

anus: liver, lung

bladder: lungs, bone, and liver

prostate: bone, liver, lungs

uterine cervix: lungs, bone, liver

colon: liver

sarcomas: lung

Lung mets

liver, adrenal glands, bone, and brain

Breast mets

lymph nodes, bone, lung, liver, brain

Stomach mets

liver

Anus mets

liver, lung

Bladder mets

lungs, bone, and liver

Prostate mets

bone, liver, lungs

Uterine cervix mets

lungs, bone, liver

Colon mets

liver

Sarcomas mets

lung

sarcoma

originating from connective tissue

oral cavity histology

squamous cell carcinoma

pharynx histology

squamous cell carcinoma

lung histology

adenocarcinoma (starts in the glands)

breast histology

infiltrating ductal carcinoma

colon and rectum histology

adenocarcinoma

anus histology

squamous cell carcinoma

cervix histology

squamous cell carcinoma

endometrium histology

adenocarcinoma

prostate histology

adenocarcinoma

brain histology

astrocytoma

levels of prevention

primary - lifestyle changes, taken early on to prevent/lower risk

secondary - screenings, PAP smears, PSA’s

tertiary - managment of cancer to prevent progression, or to make sure its not coming back

incidence rate

number of new cases

mortality rate

number of deaths per 100,000 (takes into account entire population)

survival rate

proportion of patients alive at some point after their diagnosis

prevalence

measures proportion of the population who have cancer at a specified point or during an interval of time

case-fatality rate

include fatality rates only for those who have the disease

most common cancer for both men and women

skin cancer

common cancers in men

1) prostate

2) lung and bronchus

3) colon and rectum

common cancers in women

1) breast

2) lung and bronchus

3) colon and rectum

colorectal screenings should start at what age

45 yrs for general population

FOBT

fecal occult blood test

CA-125

cancer antigen for ovarian, breast, colorectal

CA 15-3

cancer antigen for breast

CA 19-9

cancer antigen for GI (colorectal), pancreas, liver, stomach

biopsy

a surgical procedure that involved removing all or part of the tissue suspected to be cancerous

needle core

get cells from the tumor (taking a chunk)

incisional

cut off part of the lesion

excisional

removes entire tumor

histopathology

examination of cells under a microscope

carcinomas

originate from epithelial tissues

pathological grade

X - cannot be assessed (not enough information)

I - well differentiated

II - moderately differentiated

III - poorly differentiated

IV - undifferentiated

How is cancer staged?

1) start with H & P (history and physical)

2) order radiographic procedures

3) order lab tests (depends on what cancer is suspected)

Lymphoma

cancer that starts in the lymphocytes (help with the immune system)

Ann Arbor classification

used for lymphoma staging (4 stages)

Rai System

used for leukemia staging (4 stages)

Binet classification

leukemia staging

Dukes staging

Colon cancer staging (A,B,C,D)

MUGA scan

tests heart function

superimposing CT & PET

best option b/c helps see if tumors are getting smaller or larger

Hemocrit

45 (38-54) for men

40 (36-47) for women

Hemoglobin

14-18 for men

12-16 for women

Erythrocytes

5,000,000 (4.5 - 6 ×10^6) for men

4,500,000 (4.3 - 5.5 ×10^6) for women

Total leukocytes

5,000 - 10,000

Lymphocytes

1,000 - 4,000

Platelets

200,000 - 500,000

severly low < 20,000

What is the best mode of treatment for cancer

surgery

removal, diagnosing, reducing size

Hormonal therapy

changes hormone levels to reduce cancer growth/cease growth

Immunotherapy

Boosts own bodies immune system to recognize and attack cancer cells

“immune system on steroids”

What is the only way to diagnose cancer

biopsy

Curative vs palliative

curative = more aggressive

palliative = improving quality of life (first couple treatments may be higher dose to lessen symptoms)

Hypofractionization

less fractions but higher dose

Hyperfractionization

more fractions but lower dose

Adjuvant Therapy

therapy is given after primary treatment (usually surgery)

goal is to kill remaining cancer cells and lower chance of it returning

done when trying to cure

Neoadjuvent therapy

therapy is given as a primary treatment

goal is to shrink tumor, stop spread, or make inoperable tumors removable

Karnofsky Scale

measured on a 0 - 100 scale

0 = death

100 = normal

ECOG scale

measured on a 0 - 5 scale

0 = normal

5 = death

Complete response to therapy

disappearance of all measurable disease for at least 1 month

Partial response to therapy

at least 50% decrease in measurable tumor mass w/o appearance of new lesions for at 2 months

Stable response to therapy

decrease or increase of tumor mass by less than 25%

Progressive response to therapy

increase in tumor mass by more than 25% or appearance of new tumor lesion

What time frame does reaccurance usually happen

18-24 months

What is the reaccurance time frame for breast cancer

5-10 years

hence the importance of follow ups